Omission of Radiation Therapy is Associated with Inferior Disease Control in High Risk Early-Stage Hodgkin Lymphoma
In brief
Radiation raised 5-year progression-free survival from 73% to 92% in bulky Hodgkin lymphoma
In a propensity-matched study, adding radiation was linked to higher 5-year progression-free survival in patients with bulky disease (92% vs 73%) and interim PET-positive disease (75% vs 52%). Across all matched patients, the difference was not statistically significant, and radiation brought more late toxicities; prospective trials are needed to guide risk-based treatment.
- Journal
- Blood advances (Q1)
- Published
- 28 October 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Nikita K Dave, Alexandra Danielle Dreyfuss, Alison J Moskowitz, Joachim Yahalom, Maria Katerina C Alfaro, Nicole Birrer, et al.
- PMID
- 42950253
- DOI
- 10.1182/bloodadvances.2026021839
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 31 October 2026): Clinical comparison directly evaluates outcomes with versus without lymphoma radiotherapy
Abstract
Early-stage classical Hodgkin lymphoma (HL) is highly curable, yet optimal frontline treatment remains contested. Combined modality therapy (CMT) with chemotherapy followed by radiotherapy (RT) has been the standard, but concern over RT-associated toxicities has driven adoption of chemotherapy-alone approaches despite randomized trials failing to demonstrate noninferiority with RT omission. We analyzed 810 adult patients treated across eight academic centers for stage I/II HL between 1/2012 and 1/2022, comparing outcomes with CMT and chemotherapy alone. Primary endpoints were progression-free (PFS) and overall survival (OS); propensity-score matching was conducted to homogenize baseline characteristics between the groups, and subgroup analyses were conducted to identify clinical features associated with differential benefit. Among 480 propensity-matched patients, five-year OS was 98.6% with CMT versus 97.3% with chemotherapy alone (p=0.620); five-year PFS was 87.2% vs 81.4% (p=0.053). CMT conferred significantly superior PFS in patients with bulky disease (91.8% vs 73.0%; HR 3.77; p=0.005) and interim (iPET)-positive disease (Deauville score (DS)≥4; 74.9% vs 51.9%; HR 2.97; p=0.020). iPET response was the strongest independent predictor of both progression (HR 7.02) and mortality (HR 6.97), with PFS declining markedly across DS groups (DS1-2: 92.2%; DS3: 79.4%; DS4-5: 46.4%). Among iPET-positive patients, those receiving unplanned consolidative RT required less salvage therapy than those managed with chemotherapy escalation alone (29.0% vs. 45.2%; p=0.037). Late toxicities were more frequent with CMT, though 69% of second malignancies occurred outside the RT field. These findings support risk-adapted, biomarker-driven treatment selection and the need for prospective trials incorporating modern RT techniques and iPET-adapted algorithms.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.